HIV-Associated Neurocognitive Disorder

Aka: HIV-Associated Neurocognitive Disorder, AIDS Dementia Complex, Dementia in HIV, HIV Associated Neurocognitive Impairment, HIV-Associated Dementia

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II. Epidemiology

  1. HIV-Associated Neurocognitive Disorder may affect up to 30-50% of HIV patients
  2. AIDS Dementia Complex is a common complication in late AIDS

III. Pathophysiology

  1. HIV-Associated Neurocognitive Disorder is a spectrum from subtle deficits to HIV-Associated Dementia
  2. Higher severity (including Dementia) with decreasing CD4 Counts
  3. Causes
    1. Chronic neurologic inflammation and oxidative stress (latent HIV causes ongoing CNS injury)
    2. Metabolic functional abnormalities
    3. Antiretroviral neurotoxicity
  4. Involves three neurologic domains
    1. Cognitive (memory, concentration, planning, comprehension)
    2. Behavioral (apathy, depression, Agitation)
    3. Motor (Incoordination, unsteady gait, Tremor)

IV. Signs

  1. Early
    1. Impaired concentration
    2. Forgetfulness
    3. Slowed cognitive function
  2. Late
    1. Impaired rapid movements
    2. Hyperreflexia
    3. Release reflexes
    4. Weakness
    5. Ataxia
    6. Spasticity
    7. Bladder and bowel Incontinence
    8. Myoclonus

V. Differential Diagnosis

  1. See Dementia Causes
  2. See Delirium
  3. Toxoplasmosis
  4. Progressive Multifocal Leukoencephalopathy (PML)
  5. Primary Lymphoma
  6. Meningitis
  7. Neurosyphilis
  8. Psychiatric conditions
  9. Substance Abuse

VI. Imaging: Brain MRI findings

  1. Cerebral atrophy
  2. Patchy, diffuse increased white matter signal intensity
    1. Excludes other causes

VII. Labs: CSF Exam

  1. Mildly elevated Protein
  2. Mild Pleocytosis, predominance of mononuclear cells

VIII. Evaluation

  1. Montreal Cognitive Assessment (MoCA)
    1. https://www.parkinsons.va.gov/resources/MOCA-Test-English.pdf
  2. Neuropsychiatric testing

IX. Management

  1. See Mild Cognitive Impairment
  2. See Dementia Management
  3. LIfestyle modification (e.g. Exercise, cognitive training)
  4. Antiretroviral drugs
    1. May improve neuropsychiatric performance
    2. May alleviate symptoms

X. Complications

  1. Poor compliance with Antiretroviral therapy (with risk of resistance)
  2. Decreased functional capacity

XI. References

  1. Chu (2017) Am Fam Physician 96(3): 161-9 [PubMed]
  2. Jaqua (2026) Am Fam Physician 113(1): 71-9 [PubMed]

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